Colorectal cancer screening rates are sub-optimal. The primary care clinical setting represents an opportune site to maximize colorectal cancer screening. The patient-provider interaction is considered a major component of primary care whose impact on colorectal cancer screening utilization is not known. The broad objective is to maximize the delivery and utilization of colorectal cancer screening in the primary care setting. This project will specifically address the patient-provider interaction by: (1) characterizing patient-provider communication styles and perceptions of the patient-provider relationship, and (2) test their association with colorectal cancer screening behavior. To begin understanding the role of patient-provider interaction in colorectal cancer screening, the PI (Ling) obtained a National Cancer Institute Career Development Award (K07- "Delivery and Utilization of Colorectal Cancer Screening"), which began August 1, 2001. In the K07 project, the participating patient has all their clinic visits over a 12-month study period audiotaped to describe the communication content of colorectal cancer screening discussions. This R21 proposal serves to augment the present K07 study by conducting additional data collection and performing additional audiotape analyses to provide a more comprehensive assessment of the patient-provider interaction. Specifically, the R21 project will utilize the existing participants and audiotaped clinical encounters of the K07 project. The audiotapes will be analyzed using the Roter Interaction Analysis System (RIAS) to classify discussions on colorectal cancer screening into specific patient-provider communication styles. These communication styles will be tested for association with colorectal cancer screening behavior. In addition, patient and provider final interviews will be performed after the K07 project has concluded to assess the patient-provider relationship (i.e., trust, quality, and satisfaction). These domains from the final interview will be tested for association with colorectal cancer screening behavior. From the complementary activities of the R21 and K07 projects, mutable determinants of behavior toward colorectal cancer screening can be targeted in a future R01 study that tests a comprehensive, multi-faceted intervention designed to maximize the delivery and utilization of colorectal cancer screening in the primary care clinic setting.